Atrial Fibrillation Found to be Common in Patients With Atherothrombosis, Increases Risk of Cardiovascular Death, Heart Attack and Stroke

... TOKYO November 7 /- ...- Large International REACH Registry Also Shows Many Patients WithAt...A significant portion of patients with atherothrombosis also haveatri...The new findings from the REACH (REduction of Atherothrombosis forCon...

- Large, International REACH Registry Also Shows Many Patients With
Atrial Fibrillation are Undertreated With Antiplatelet and Anticoagulant
Therapies

A significant portion of patients with atherothrombosis also have
atrial fibrillation (AF), greatly increasing their risk for cardiovascular
death, heart attack and stroke, according to new findings from the large,
international REACH registry published today in the American Heart
Journal.(1) The findings also showed that standard treatments including
anticoagulant and antiplatelet therapies are underused in AF patients.

The new findings from the REACH (REduction of Atherothrombosis for
Continued Health) registry showed that AF was present in approximately 12%
of patients who had atherothrombotic disease, which includes coronary
artery disease (CAD), peripheral artery disease (PAD), and cerebrovascular
disease (CVD). The findings also showed that, among patients with or at
risk for atherothrombotic disease, the risk for death and non-fatal
cardiovascular outcomes was greater for AF vs. non-AF patients, including
more than twice as high for CV death (3.2% vs 1.4%; p<0.0001), 87% higher
for death from all causes (4.3% vs. 2.3%, p<0.0001), 50% higher for
non-fatal stroke (2.4% vs 1.6%, p<0.0001), and nearly 50% higher for the
combined endpoint of CV death/heart attack/stroke and/or hospitalization
for atherothrombotic events (17.9% vs 12.1%, p<0.0001). Despite these
higher risks in AF patients, only a little more than half received
anticoagulant therapy, only 60 percent received antiplatelet therapy, and
less than one in five received both.

"We've known that AF is a major risk factor for ischemic stroke, but
its prevalence and impact in the broader population of patients with
atherothrombosis was previously unclear," said, lead author Shinya Goto,
MD, PhD, FACC, Department of Medicine, Tokai University School of Medicine,
Kanagawa, Japan. "Our findings help fill that gap, and show across all
atherothrombotic disease categories, AF consistently increases the risk of
death and non-fatal CV outcomes. For example, the combined endpoint of CV
death, heart attack and stroke and/or hospitalization for atherothrombotic
events was higher in AF patients no matter what form of atherothrombotic
disease they initially had, and was highest in patients initially recruited
with PAD. Further, our analysis underscores the need to determine the
optimal management of AF patients with or at risk for atherothrombosis."

About the New REACH Analysis

The REACH registry is a large, contemporary, representative and
geographically diverse cohort of stable outpatients with or at high risk of
atherothrombosis.2,(3),(4) A total of 68,236 patients with either
established atherothrombotic disease (CAD, PAD, or CVD, n=55,814) or at
least three risk factors for atherothrombosis (n=12,422) were enrolled from
5,587 physician practices in 44 countries (in Europe, North and South
America and Asia) in 2003-2004.

For this new analysis, the investigators identified REACH registry
patients with or without AF, then compared those two groups in terms of
risk factors, drug usage and one-year cardiovascular (CV) outcomes (CV
death, heart attack and stroke).

AF status and one-year follow-up data were available for 63,589
patients. The prevalence of AF was 12.5%, 13.7%, 11.5%, and 6.2% among CAD,
CVD, PAD, and risk factor-only patients, respectively; and 11.7% in
patients with symptomatic atherothrombotic disease (CAD, CVD, or PAD
together as one group). These prevalence rates are substantially higher
than the estimated prevalence in the general population aged 40 years or
more (2.3%) or 65 years or more (5.9%).(5)

Of the total 6,814 AF patients, 6.7% experienced CV death, non-fatal MI
or non-fatal stroke within a year. Among the findings, the investigators
showed that, after statistically adjusting for differences including age,
sex, smoking, hypertension, diabetes, and hypercholesterolemia, the risks
for death and non-fatal CV outcomes were worse in AF vs. non-AF patients:

- CV death 129% greater (3.2% vs 1.4%; p<0.0001)

- All-cause death 87% greater (4.3 vs 2.3, p<0.0001)

- Non-fatal stroke 50% greater (2.4% vs 1.6%, p<0.0001)

- The combined endpoint of CV death/heart attack/stroke and/or

hospitalization for atherothrombotic event 48% greater (17.9% vs

12.1%, respectively; p<0.0001), and highest in patients initially

recruited

with PAD (27.1%)

Only 58.4% of AF patients received antiplatelet agents, and only 53.1%
received anticoagulant therapy. The rate of bleeding requiring
hospitalization was higher in AF vs non-AF patients, respectively: 1.5% vs
0.8% (p<0.0001); the investigators speculated that this may have been due
to the more frequent use of anticoagulants (53.1% vs 7.1%).

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